The Terumo Capiox centrifugal pump system possesses an automatic priming function in which the motor repeatedly stops and runs intermittently to eliminate air bubbles in the circuit through the micropores of the hollow-fiber membrane oxygenator. By modifying this mechanism, we have developed a pulsatile flow mode. In this mode, maximum and minimum pump rotational speeds can be independently set every 20 rpm in the range of 0 to 3,000 rpm. The duration of the pump run at maximum and minimum speeds can also be independently set every 0.1 s in the range of 0.2 to 15 s. In a clinical trial, after obtaining the desired flow rate, 2.4 L/min/m2 in nonpulsatile flow mode, a pulsatile flow mode of 60 cycles/min (with 1 cycle being maximum speed for 0.4 s and minimum speed for 0.6 s) was obtained by adding and subtracting 500 rpm to and from the rotational speed in nonpulsatile flow mode. Pulse pressures in the femoral artery and in the circuit just proximal to the perfusion cannula (6.5 mm Sarns high flow cannula with metal tip) were measured in 5 patients who underwent pulsatile cardiopulmonary bypass (CPB) for a coronary artery bypass graft (CABG), and compared to pulse pressures obtained by intraaortic balloon pumping (IABP) in 3 patients and by the pulsatile mode of the 3M Delphin pump in 3 patients. The platelet count, free hemoglobin, and beta-thromboglobulin (beta-TG) were measured and compared with measurements from another 5 patients who underwent nonpulsatile CPB. Although the pulse pressure measured in the circuit was 180 mm Hg on average, the pressure in the femoral artery was only 15 to 40 mm Hg with a mean of 20 mm Hg. In the same patients, 60 to 80 mm Hg pulse pressure was obtained with IABP. The pulse pressure obtained with the Delphin pump was not more than that obtained with the Terumo pump. There were no significant differences in percents of preoperative levels of platelet counts (pulsatile, 87.6 +/- 15.8% and nonpulsatile, 72.4 +/- 40.6%), free hemoglobin (pulsatile, 18 +/- 8 mg/dl and nonpulsatile, 25 = 7 mg/dl), and beta-TG (pulsatile 298 +/- 28 ng/ml and nonpulsatile, 312 +/- 143 ng/ml). In conclusion, although the pulsatile mode of the Terumo centrifugal pump did not exhibit any adverse effects hematologically, the pulse pressure obtained was unsatisfactorily small, mainly because of dumping caused by the perfusion cannula.

Background Effective alternatives to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) remain unestablished. Dual-chamber (DDD) pacing was evaluated in these patients using right atrial (RA) and epicardial left ventricular (LV) leads. Methods and ResultsIn 6 patients with HOCM refractory to medical therapy and conventional RA-right ventricular (RV) DDD pacing, we implanted DDD pacemakers using RA and epicardial LV leads. The baseline intraventricular pressure gradient before pacemaker implantation was 103±44 mmHg. The pressure gradient decreased significantly to 8±16 mmHg by temporary RA-LV DDD pacing (p=0.006), while it decreased only to 68±25 mmHg by temporary RA-RV pacing (NS). It was nearly eliminated to 1±2 mmHg (p=0.027) 3 months after RA-LV DDD pacemaker implantation. LV end-diastolic pressure, cardiac index and systolic aortic pressure did not change significantly. New York Heart Association class improved in all patients (p=0.023). Brain and atrial natriuretic peptide concentrations, respectively 516±286 and 143±34 pg/ml at baseline, decreased significantly to 230±151 and 93±44 pg/ml 3 months after implantation (p=0.027 and 0.028). Conclusion RA-LV DDD pacemaker implantation is a useful option for patients with symptomatic HOCM. (Circ J 2005; 69: 536 -542)

Backgrounds While there is a concern about the increase in the occurrence of acute aortic dissection caused by the worsening of hypertension, mental stress, etc., there is a lack of data regarding the influence of disasters on this event. The aim of this study was to address this issue in the acute-subacute phase after the Kumamoto Earthquake occurred on April 14 2016. Methods We retrospectively investigated the impacts of the Kumamoto Earthquake on various cardiovascular diseases, including acute aortic dissection, utilizing the medical records of patients in 16 hospitals in Kumamoto Prefecture during the period from April 14 to June 30 (78 days) in 2014, 2015, 2016, and 2017. Results The occurrence of heart failure and venous thromboembolism increased significantly in the acute-subacute phase after the earthquake. When comparing the earthquake year (2016) to the non-earthquake years (2014, 2015 and 2017), the difference in the occurrences and mortalities of acute aortic dissections were not significant. When other characteristics of the patients were compared between the earthquake year and the non-earthquake years, there were no differences. Conclusions It might be possible that the Kumamoto Earthquake did not affect the incidence of acute aortic dissection or deaths from acute aortic dissection, possibly because the climate was mild and the preventive efforts based on previous experience were successful.

A 69-year-old woman was admitted with severe hypertension and intermittent claudication. The results of further examination, showed that the hypertension and intermittent claudication were due to stenosis of the descending aorta and we diagnosed atypical aortic coarctation. We performed median sternotomy and ventrotomy with side-to-end anastomosis a woven Dacron graft and the ascending aorta. The graft was passed through the lesser omentum, and mesocolon and to abdominal aorta. The postoperative state was stable, and the hypertension and intermittent claudication were remarkably ameliorated. Many cases of extra-anatomical bypass were reported, and the ascending aorta-abdominal aorta bypass was useful method and, very successful with no complications in this case.

A 76-year-old woman presented with shortness of breath and dyspnea after the intake of meals. Chest X-ray showed pulmonary congestion and pleural effusion. Computed tomography disclosed a hiatus hernia. Echocardiography demonstrated that the motion of the posterior wall in the left ventricle (LV) was paradoxically by the hiatus hernia, although LV ejection fraction was preserved. The restriction of LV by hiatus hernia could cause heart failure and open surgical repair of the hiatus hernia was performed. Dyspnea after the intake of meals disappeared and no recurrence of heart failure was observed in the subsequent period of several years.